| NPI | 1285629840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3009) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI 524) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2009-12-23 |